My son was diagnosed when he was two and a half. His A1c is usually over 10 and I am concerned that this could be causing him early damage. I have been pushing for the pump but our diabetes team keeps giving us the thumbs down. Their reasoning is that he should gain better control first. I think that’s like waiting to be in an accident and then putting your seatbelt on and, by that time, real damage will be done. Should I change endocrinologists?

Here’s the deal. It takes two, you and me to do this….actually, mostly you.

When I see an A1c of 10, I worry, is the child getting all the insulin? Are you “forgetting” some of it? A missed bedtime long acting insulin shot can take days to fix. How often are you checking his blood sugar? How often are you correcting the highs? Clearly, the correcting is easier with a pump, but I had a medical student comment and we published an abstract at ADA on missed doses even with over 300 blood sugars.

I expect your team is worried that you will not do the things needed to manage with a pump. If you don’t check a glucose at bedtime and miss a 400 mg/dl [22.2 mmol/L] caused by a bad site or a dead pump, you will be at the hospital in DKA before breakfast. Pumping is not a free lunch…it is a lot of work…again for you, not me. I always marvel at the work needed to manage diabetes and dedication of families to get there. Keep it up.

All that said, pumping gives the best A1cs for most people. Do all the above and ask for a pump.

LD